Psychosis: Between Dreams and Perceptual Reality
Keywords:psychosis, dreaming, REM sleep, lucid dreaming
From the beginning of time, the layman always described and understood psychosis as a dream-like state. Researchers have characterized both psychosis and dreaming with common denominators, both displaying visuomotor hallucinations, loose associations, metacognitive deficit, impaired reality discrimination, strong emotional component, resulting in a general lack of insight. The association of psychosis with dreaming was present in literature centuries ago, in the works of great thinkers such as Kant and Schopenhauer, which prompted many modern specialists to delve deeper into studying this connection for a better understanding of psychosis and possible applications in the clinical practice. During REM sleep, which is the most associated with dreaming, visual and motor areas in the brain show increased activation, which is congruent with the presence of hallucinations, the hallmark of the dreaming state. Also, the amygdala, involved in emotion regulation, has a prominent role in the sleeping brain. The deactivation of parts of the prefrontal cortex translate in altered capacity for making decisions and critical thinking. Several neuroimaging studies have shown similar neural patterns in the wakeful state of psychotic patients, especially those associated with the presence or absence of insight. As insight is thought to play a major role in treatment compliance and quality of life in psychotic patients, it is the most studied element linking psychosis and REM sleep. Lucid dreaming is a state of awareness of dreaming, while the individual is still asleep. The dreamer has a degree of control of the narrative and capacity for self-reflection, aspects deemed as insight. Lucid dreaming is a rare occurrence, but has the potential to be trained, concept with great relevance in researching modalities for insight gain in psychotic patients. In conclusion, the research of insight present in lucid dreaming shows great prospect for developing better interventions that target the lack of it in psychotic patients, thus contributing to significant improvement in their prognosis, quality of life and treatment compliance.
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